Talking Mats and Autism- Have you sometimes tried it and it didn’t work?

There is a growing interest in teaching TM to people with ASD. We know that some important adaptations might be required to make this a meaningful experience, and are keen to share our learning so far.

Being asked for thoughts or views can be difficult for some people with communication difficulties.  In particular, there is a group of people with autism where some of the core principles of Talking Mats have to be taught in stages.   Some thinkers will just ‘get it’ and find it a valuable tool for sharing their thoughts and for supporting decision making.  For others there may have to be adaptations and /or  specific teaching e.g. the vocabulary of the top scale.  We heard recently of a student in a specialist centre who couldn’t use Talking Mats.  However the staff would include him in groups where it was used and make sure he was around others doing Mats.  After a few years, he did learn the principles and go on to use it effectively.

We have gathered ideas and knowledge from practitioners working in the field of autism and included these on our web-site under Free Stuff on Communication Disability.  ASD guidelines  It’s important that these guidelines grow and adapt as we learn more about using TM with an even wider range of people.

We’ve arranged a twilight session here at Stirling on the 1st of February 2018  to bring together practitioners working in the field of autism to extend our knowledge and encourage a staged approach to effective use of Talking Mats.
We’re delighted that Ruth Chalmers, Principal Teacher for Autism Spectrum Info and Support Team (ASIST) in Fife will be joining us to talk about developing social communication skills using Talking Mats. There will be time for small group chat so bring along a case you want to discuss.
Please share the attached flier 201802 AsD seminar with your network and we hope you can join us

Please come along and   If you are interested in attending this twilight session 4.00pm to 6.00 pm (cost £20.00),  please notify us at info@talkingmats.com

This story, which highlights the importance of finding out what really matters to people, was shared by one of the staff attending the second day of an enhanced Talking Mats training course. She works in a NHS facility for people assessed as needing hospital-based continuing care.

I was working with Bill (not his real name) who is a man with severe cognitive impairment resulting from a head injury and stroke. He was very angry and agitated and we couldn’t work out what was wrong. At times he was physically aggressive when we couldn’t understand him.

One day he drew a picture of a rabbit and was very insistent about it but we didn’t know what it meant. We contacted his sister about him being angry about a rabbit. She asked around to other family members and friends but no one could think what it meant.

Bill continued to draw a rabbit and then other pictures including money and TV  so I made an improvised Talking Mat using his drawings as the options and began trying to find out what really mattered to him. I gradually connected that the TV was about about programme called Dickinson’s Real Deal (a TV programme about antiques) and that in the past Bill had had an ornament of a rabbit which he thought was worth a lot of money.

We phoned his sister again about a possible rabbit ornament and she then remembered that he had collected figurines in the past. She finally discovered the rabbit in her garage.

Once we were able to reassure Bill that his rabbit was safe his frustration lessened,he was much less angry and became more settled.

This lovely story shows us how important it is to never assume that someone is just ‘being difficult’  but that if we can try to find out what really matters to them we can make a huge difference to their lives and ours.

Huge thanks to all the practitioners who have sent us guest blogs. We selected our 10 favourite guest blogs…in no particular order!

1.  Talking Mats to support children who stammer Kirsten Taylor, Speech and Language Therapist tells a moving story about how finding out what was upsetting a boy with a stammer helped to implement change.
2. Hearing the voice of the child Emma Atkiss, Senior Educational Psychologist, shares her findings from the Wigan Pathfinder project reporting that using a Talking Mat helps to meet the 5 criteria of Shier’s model of participation.
3. Talking Mats for capacity assessments in people with ASD/LD Ruth Spilman, Senior SLT from The Cambian Group, shares practical tips on assessing capacity.
4. Castle hill school supports pupil voice Jenna McCammon, SLT and Rebecca Highton, SLT Assistant, tell 3 inspiring stories using TMs in: selective mutism; safeguarding and motivational interviewing.
5. Supporting Looked After Children to have their say Karen Wilson, Principal Teacher for children with additional support needs in a mainstream secondary school  shares her experience of using TMs to give young people a stronger voice in making decisions affecting them.
6. Hearing the voices of Looked After Children Rachel Clemow, Head Teacher and Donna Wood, Education Support Worker, report that Talking Mats has enabled children to express their thoughts and views in a safe, neutral environment.
7. Talking Mats and Mental Health  Carla Innes, Clinical Psychologist for learning disability from Healthy Young minds Stockport talks about the impact of TM training on the whole team.
8. Mummy I don’t want to go to nursery today read about how using a Talking Mat might shed some light on why a 4 year old was upset at the thought of going to nursery.
9. How do you feel about starting school? The story of 4 year old twins and their thoughts about starting school.
10. Sibling Attitudes Prof Juan Bornman from Pretoria in South Africa publishes a report on a study carried out with 27 typically developing children who have a younger sibling with a severe speech and language disability.

If you have been inspired and are not yet trained to use Talking Mats – come along to one of our training courses.

We’re always amazed to hear from people about the variety of topics they cover using Talking Mats –from how someone is managing their self care or domestic tasks, to arranging a wedding, or thinking about whats important at a funeral.

As a communication tool Talking Mats maximises a person’s capacity to reflect on a topic and express their view.   It gives confidence in decision making.

Here are some other topics we’ve heard about recently.

• As a conversation tool in class
• Pupil voice in school improvement plan
• Client contribution to meetings and review day placement
• Respite
• Operations e.g. gastrostomy
• Health
• Postural management
• Where to live
• Childs opinions in relation to GIRFEC
• Respite feedback/choices
• SW assessments
• Choices available within service
• Going somewhere new
• Transitions
• Problem solving ie horse riding, identifying the problem
• Eating and Drinking
• Keeping Safe
• Social Media

What do you want to talk about?  There is no limit!

Laura, shares a story from a speech and language therapy colleague. Her 4 year old daughter  was getting upset at the thought of going to nursery; she wanted to see if using a Talking Mat might shed some light on why she was upset as the reasons were unclear.

Topic: Nursery

Top Scale: Like/ Don’t know/ Don’t Like
Options: 14 in total, focusing on different aspects of Nursery involving      staff, other  children, activities and environment.
The parent reports that her child was very engaged when doing the Mat, and took the photo of her completed mat at the end. Mum took the role of the ‘Listener’ however Dad was also there watching, so the child had the attention of both her parents.
The completed mat indicated that the child liked a number of aspects about nursery, however did not like ‘smell’, ‘sound’ and playing games with other children outside. The parent then fed this information back to nursery staff who are now monitoring these areas in order to gain further information.
This further information from staff will help to provide ideas regarding possible options to sub-mat in the future, using the topics of ‘smell’, ‘sound’ and ‘playing outside’, and therefore enabling this child to communicate her feelings about these areas in more detail.

Those of us who are parents can find ourselves in the position of trying to work out why our child is behaving in a certain way. Sometimes a change in behaviour can be very sudden. Often the underlying reason can be far removed from what we assume it is.
Talking Mats can help in this situation, as it provides a visual, picture-based framework to focus on, supporting discussion between parent and child. Children will often share more information using a Talking Mat as opposed to a purely verbal discussion. Talking Mats is less confrontational and puts the child in control, as the ‘Thinker’.

Health professionals from Stockport have shared how using Talking Mats has positively impacted on their clinical work.

Laura, our North West  Associate, met up with Carla Innes, Clinical Psychologist for learning disability from Healthy Young minds Stockport (a child and adolescent mental health service provided by Pennine Care NHS Foundation Trust) and Clare Royle, Family Support Worker,from the Children’s Learning Disability Team (provided by Stockport NHS Foundation Trust). The two organisations work closely together to provide joined up care to young people with a learning disability.

Six months ago Carla, Clare and seven others from the Healthy Young Minds Stockport Team  received training to enable them to introduce Talking Mats as part of their challenging behaviour pathway.

Carla and Claire said that the staff team are very positive about the impact of Talking Mats. The overall impression is that Talking Mats has enabled staff to gain an individualised sense of the child or young person they are working with, as well as empowering the children and young people to share their views and opinions. Carla also notes that using Talking Mats has helped her to focus on the child/young person’s abilities/potential – their ‘zone of proximal development’ – and to ensure that everyone is working within that.
Some of the other positive features of using Talking Mats include:
– Providing ‘headspace’ for the child/young person to process their thoughts and to really consider what is important to them.
– Giving a holistic, child/YP centred account and narrative of their feelings and behaviour.
– Helping to inform and direct clinical decision making e.g. introduction of an approach such as CBT.
– Enabling children/young people who have previously refused, or been very reluctant, to share their views and opinions about topics which have been troubling them for example, school attendance and issues with sleep.
– Providing of a communication framework which is neutral and non-threatening – much less intense than direct verbal questioning or conversation.
– Helping to make abstract concepts more concrete for the listener to understand.
– Being a safe, flexible and quick method of finding practical solutions and determining direct actions.
– Enabling the listener to gain a better understanding of the thinker’s level of knowledge and understanding about a particular topic such as healthy eating. This can help inform capacity assessments e.g. in terms of medical consent or the use of medication. The mental capacity act states that appropriate support should be given to young people to make informed decisions and to communicate those decisions.
In addition, from a wider team perspective, Carla and Clare report that they have all noticed benefits in terms of consistency of Talking Mats use by all members of the multi-disciplinary team. Each team member using the Talking Mats tool is working from a slightly different perspective; using Talking Mats ensures that the child/young person is kept at the centre of the process. This results in a truly holistic view of the child/young person’s feelings, views and opinions.

It was great to meet with Nikki Steiner, Principal Speech and Language Therapist with Central London Community Health Care Trust (CLCH), to evaluate the work that was commissioned by CLCH. The project started in the spring of 2016 and aimed to support a person-centred and inclusive approach to health planning and intervention using the Talking Mats framework.

Those words ‘person-centred’ and ‘inclusive’ are easy to say but much harder to implement. Our approach was threefold:

1. We provided 100 staff with the Talking Mats resources to use in their practice (both the original and digital versions).
2.  We ran 3 Enhanced Talking Mats training courses for those staff which involved two days training. The first day introduced the framework and built staff confidence in using the resource. The second day supported staff to reflect on their use of the Talking Mats in their work setting, and allowed them to think creatively about further application and development.
3. To sustain the capacity of CLCH to continue with the project we trained three accredited trainers. The plan is they will continue to build staff skills and training on an on-going basis and provide local leadership and expertise.

The evaluation framework that we are using looks at impact of this investment using the Kirkpatrick model of evaluation. This allowed us to evaluate:

1. Participants’ reaction to the training,
2. Participants’ learning – did they increase their knowledge skills and learning?
3. Transfer and application – did they apply their learning to the workplace?
4. Result – this was based on the impact that using the Talking Mats skills and resources had on the lives of people with communication disability

We had different measurements for each part of the model and these ranged from course feedback, a quiz, personal reflection and stories from people with communication difficulties. It is these that we are in the process of analysing so watch this space for the final report. Nikky said ‘This is such an exciting project that impacts on all the different client groups that we support’.

If you would like to discuss implementing Talking Mats at an organisational level then have a look at this link – Organisational Training

We are very grateful to Mary Walsh, Senior Speech and Language Therapist at St Mary’s Hospital in Dublin, for her Blog ;Does he like fairy cakes? ‘ It has been taken from her report on a project which looked at how speech and language therapists can facilitate the involvement of people with dementia to become more active participants in the decision making process around dysphagia management at the end stage of dementia. The project was funded by the Irish Hospice Foundation Changing Minds Programme

 The project aims were:

1. To improve person centred care in relation to residents’ food and drink preferences and dislikes
2. To actively involve the residents of the dementia specific unit in the decision making process around their dysphagia (swallowing) management particularly at the end stage of their lives.

In order to find out the food and drink preferences and dislikes of the residents, the team carried out staff questionnaires and family questionnaires. They found that, although these were useful in getting a quick overview, there were a lot of unanswered questions.

The team also used Talking Mats and found it to be a powerful way to explore the residents’ food and drinks preferences and dislikes when used with suitable candidates. Participants appeared to really enjoy the experience including looking at pictures of the completed mats afterwards. This may be because they felt heard, that their views mattered and/or that they felt empowered. The information was important for current Dysphagia management, and also as an advanced directive in the documented evidence of the residents’ wishes in the recorded pictures of completed mats.

 Brief Case Study:  Does he like fairy cakes?

Talking Mats was used with a gentleman who may have been assumed to be unsuitable to use Talking Mats as he was assessed as having late stage dementia. However, this man engaged readily in the Talking Mats interview and appeared to be happy to have his views recorded. Also, there was a much higher level of correlation than variance with Talking Mats and both the staff questionnaire and the family questionnaire thus further indicating that he was a suitable candidate. ‘Fairy cakes’ was something that this resident reportedly liked in both the staff questionnaire and the family questionnaire. However, the gentleman indicated twice on Talking Mats that he disliked fairy cakes.

 A number of actions are proposed in the report including :

1. Continue to use Talking Mats as appropriate in the dementia specific residential unit and the rehabilitation wards of St. Mary’s Hospital.
2. Inform the multi-disciplinary team of the merits of Talking Mats. This tool can also be used to explore other important issues for suitable residents/ patients on a case by case basis.

Conclusion:

It is essential to challenge our assumptions in our dealings with people with dementia. Truly person centred care takes time and patience where assumptions are challenged. Also, it is essential to listen to what residents tell us verbally, or through a supported communication system such as Talking Mats or non-verbally through tone of voice, facial expressions or gestures, and to act according to what is being communicated.

To read the full report please contact Mary Walsh at mary.walsh6@hse.ie To find out more about a Talking Mats resource that specifically focuses on finding out views on eating and drinking then please click here 

Many thanks to Shirley Rush Health Facilitator at Belfast Health and Social Care Trust for this great blog about using TM as a ‘weigh to health’.

Following my Talking Mats (TM) training I had the opportunity, as a health facilitator, to use TM in an adapted ‘Weigh to Health’ course. This course encouraged people with learning disabilities to make small changes to their lifestyle and to educate them on the effects of obesity and their health.

Prior to commencing the group work we met with each person and completed a Talking Mat. The topic was to explore “Important things to lose weight”, we used a wide range of symbols and included physical activity, health conditions and appearance. Clients also requested additional symbols were added including alcohol, cycling and mood, which made the mat individual to them.

A photograph was taken of the completed TM to act as a record of what was important to them. On completion of the group the TM was repeated with each person using the same topic and symbols and the mat was again photographed. When we compared the TMs it showed that all the client’s knowledge and understanding of the effects of obesity and the health benefits associated with weight loss had increased.
“it done me good, helped me to lose weight by talking about my health and the need to lose weight to look after my heart”

The use of the talking mat was a valuable resource, it allowed each client to make an informed choice about participating in the group work. One client said he felt he had been listened too and “it done me good, helped me to lose weight by talking about my health and the need to lose weight to look after my heart”. By using TM in this way we have been able to use this information to demonstrate outcomes and it shows the information was presented at a level of understanding suitable for the client group. On an easy read questionnaire about the course all the clients agreed that doing the TM was useful, one person wrote “loved doing the mat”.

If you want to get more information from Shirley contact her at Shirley.rush@belfasttrust.hscni.ne

We have received a number of requests to create a guide to adding your own images and creating submats with Digital Talking Mats and this blog will show you how.

One of the features of Talking Mats is that we have developed a number of different symbol resources based on our research and clinical practice which cover a wide range of topics.
However, sometimes you may want to personalise what is being communicated about by adding your own images. You may also want to create a submat to explore an existing topic in more detail or you may want to create a completely new topic. In our training courses we explain how to do this when using the original Talking Mats.

However more and more people are now using the digital version of Talking Mats. In a previous blog we described how to add your own photos to the Digital Talking Mats.

We have now made a guide to help those who have the digital version to both add their own images and to create a submat with an example of a sub-mat with the topic “office”.

Download the following pdf to find out how to do it. dtm-a-guide-how-to-add-photos

We would love to hear any stories about making your own digital submats